Evid Based Nurs 8:32 doi:10.1136/ebn.8.1.32
  • Qualitative

Older African-Americans with osteoarthritis of the knee preferred to avoid total knee replacement surgery

 Q What are the preferences and expectations of older urban African-Americans regarding total knee replacement (TKR) for osteoarthritis (OA) of the knee?


Qualitative study based on the theory of reasoned action as a model of behaviour.


Communities in northern Manhattan, New York, USA.


94 African-Americans >50 years of age (mean age 71 y, 84% women) with medical insurance, who had pain or stiffness in one or both knees that made walking difficult or slow during the previous 6 months, and who lived or attended church or a senior centre in Harlem. 13% of patients had had TKR.


Data were collected during 45–75 minute structured face to face or telephone interviews that included both closed and open ended questions. Responses to open ended questions were recorded and transcribed verbatim. Major themes were developed through a process of categorisation.


Preference for natural remedies. 36% of patients thought that OA was caused by cold or dampness, either to the joint or from the environment. They tended to think that OA was a natural, irremediable, inevitable deterioration and a sign of ageing. A strong trend toward an external locus of control of their illness was suggested: “I do not claim arthritis. God has not told me I …

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